Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer
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Laparoscopic surgery has been widely accepted for the treatment of colorectal cancer; however, long-term outcomes in elderly patients remain controversial. The midterm results of a randomized trial comparing open surgery with laparoscopic surgery in elderly patients with colorectal cancer are presented.
This was a randomized trial comparing open surgery with laparoscopic surgery in elderly patients with colorectal cancer. The primary outcome was complication rate, and secondary outcomes included 3-year recurrence-free survival and overall survival. A total of 200 patients were randomly assigned to open surgery or laparoscopic surgery between 2008 and 2012. The main study objective was to compare the midterm outcomes of open surgery with those of laparoscopic surgery in elderly patients with colorectal cancer. This trial is registered with Clinical Trials.gov (NCT01862562).
There were no differences between the laparoscopic surgery group and open surgery group in the 3-year overall survival rate (91.5% for laparoscopic surgery vs. 90.6% for open surgery, p = 0.638) or the 3-year recurrence-free survival rate (84.8% for laparoscopic surgery vs. 88.2% for open surgery, p = 0.324). The local recurrence rate was significantly higher in the laparoscopic surgery group than in the open surgery group in rectal cancer (13.8% for laparoscopic surgery vs. 0% for open surgery, p = 0.038). In subgroup analysis according to tumor location, there were no significant differences in the 3-year overall survival rate or 3-year recurrence-free survival rate between the two treatment groups.
The midterm outcomes of laparoscopic surgery are similar to those of open surgery in elderly patients with colorectal cancer.
KeywordsLaparoscopic surgery Elderly patient Colorectal cancer Randomized study
Ishibe Atsushi and Fujii Shoichi contributed to the study conception and design. Ota Mitsuyoshi, Yusuke Suwa, Shinsuke Suzuki, Hirokazu Suwa, Jun Watanabe, and Kazuteru Watanabe contributed to data acquisition. Ishibe A contributed to data analysis, interpretation, and writing the report. Masataka Taguri contributed to statistical analysis. Chikara Kunisaki and Itaru Endo contributed to editing, reviewing, and final approval of the report.
Compliance with ethical standards
Drs. Atsushi Ishibe, Mitsuyoshi Ota, Shoichi Fujii, Yusuke Suwa, Hirokazu Suwa, Masashi Momiyama, Jun Watanabe, Kazuteru Watanabe, Masataka Taguri, Chikara Kunisaki, and Itaru Endo have no conflicts of interest or financial ties to disclose.
- 2.National Cancer Center Japan PCSRCf, Cancer Control and Information Services CIS.Google Scholar
- 5.Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMedGoogle Scholar
- 9.Fujii S, Ishibe A, Ota M, Yamagishi S, Watanabe K, Watanabe J, Kanazawa A, Ichikawa Y, Oba M, Morita S, Hashiguchi Y, Kunisaki C, Endo I (2014) Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc 28(2):466–476CrossRefPubMedGoogle Scholar
- 13.Vallribera Valls F, Landi F, Espin Basany E, Sanchez Garcia JL, Jimenez Gomez LM, Marti Gallostra M, Salgado Cruz L, Armengol Carrasco M (2014) Laparoscopy-assisted versus open colectomy for treatment of colon cancer in the elderly: morbidity and mortality outcomes in 545 patients. Surg Endosc 28(12):3373–3378CrossRefPubMedGoogle Scholar
- 14.Niitsu H, Hinoi T, Kawaguchi Y, Ohdan H, Hasegawa H, Suzuka I, Fukunaga Y, Yamaguchi T, Endo S, Tagami S, Idani H, Ichihara T, Watanabe K, Watanabe M. (2015) Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan. J Gastroenterol 51(1):43–54Google Scholar
- 16.Moon SY, Kim S, Lee SY, Han EC, Kang SB, Jeong SY, Park KJ, Oh JH. (2016) Laparoscopic surgery for patients with colorectal cancer produces better short-term outcomes with similar survival outcomes in elderly patients compared to open surgery. Cancer med 5(6):1047–1054CrossRefPubMedPubMedCentralGoogle Scholar
- 18.West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J clin oncol 30(15):1763–1769CrossRefPubMedGoogle Scholar
- 20.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. The Lancet 365(9472):1718–1726CrossRefGoogle Scholar
- 21.Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: The ACOSOG Z6051 randomized clinical trial. Jama 314(13):1346–1355CrossRefPubMedPubMedCentralGoogle Scholar